CLINICAL
REVIEW
Home Modifications: Occupational Therapy
Indexing Metadata/Description
› Procedure: Home Modifications
› Synonyms: Housing adaptations
› Area(s) of specialty: Geriatric Rehabilitation, Home Health
› Description/use
• Occupational therapist provides in-home safety assessments for patients to ensure a safe
home environment(1)
• Home safety assessments and home modifications are important services provided by an
occupational therapist in order to identify home hazards for patients who are at risk for
falls
–Home safety assessments are provided for patients who may have had recent
hospitalization or extended stay at a skilled nursing facility as a result of orthopedic
surgeries, recent history of falls, spinal cord injuries, or traumatic brain injuries
• Effective home modifications by the occupational therapist can allow the patient to
remain in his/her home
• Complex environmental modifications (CEMs) can include structural changes (to the
environment), incorporation of assistive technologies, and services in order to “facilitate
optimal participation in daily life”(15)
› Indications:
• Impairments
– High risk for falls(1)
– Visual impairments(2)
– Limited accessibility for new wheelchair users(16)
Author
Lisa Schulz Slowman, MS, OT/L, CHT
Cinahl Information Systems, Glendale, CA
Reviewer
Brian Dy, DPT
Cinahl Information Systems, Glendale, CA
Editor
Sharon Richman, MSPT
Cinahl Information Systems, Glendale, CA
March 31, 2017
–Decreased functional ambulation, strength, or endurance
• Functional limitations
–Patients may have functional limitations that result in poor mobility and poor ability to
perform activities of daily living (ADLs). Some examples are:
- limited functional strength,necessitating grab bars by toilets, showers, or stairs
- pain as a result of arthritis requiring modifications to door handles, faucets, cabinets
- difficulty with stair ambulation may be addressed by a stair glide
- difficulty accessing bathtubs or showers may be improved with walk-in/roll-in
bathtub or shower
- inability to reach necessary items in the kitchen may be addressed by rearranging
kitchen storage or modifying cabinet heights and styles
- patients may be limited by pain due to arthritis and require modifications to their
home to make ADLs easier to perform, for example moving laundry facilities from a
basement to the living floor of the home
• Risk factors
–Persons 65 years or older are at risk for falls
–Physical impairment
–Cognitive decline
› CPT codes:
• S5165 Home modifications; per service
Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2017, Cinahl Information Systems. All rights
reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by
any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice
or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare
professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206
› G-Codes
• Mobility G-code set
–G8978, Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at
reporting intervals
–G8979, Mobility: walking & moving around functional limitation; projected goal status, at therapy episode outset, at
reporting intervals, and at discharge or to end reporting
–G8980, Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end
reporting
• Changing & Maintaining Body Position G-code set
–G8981, Changing & maintaining body position functional limitation, current status, at therapy episode outset and at
reporting intervals
–G8982, Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at
reporting intervals, and at discharge or to end reporting
–G8983, Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end
reporting
• Carrying, Moving & Handling Objects G-code set
–G8984, Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at
reporting intervals
–G8985, Carrying, moving & handling objects functional limitation, projected goal status, at therapy episode outset, at
reporting intervals, and at discharge or to end reporting
–G8986, Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end
reporting
• Self-Care G-code set
–G8987, Self-care functional limitation, current status, at therapy episode outset and at reporting intervals
–G8988, Self-care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at
discharge or to end reporting
–G8989, Self-care functional limitation, discharge status, at discharge from therapy or to end reporting
• Other PT/OT Primary G-code set
–G8990, Other physical or occupational primary functional limitation, current status, at therapy episode outset and at
reporting intervals
–G8991, Other physical or occupational primary functional limitation, projected goal status, at therapy episode outset, at
reporting intervals, and at discharge or to end reporting
–G8992, Other physical or occupational primary functional limitation, discharge status, at discharge from therapy or to end
reporting
• Other PT/OT Subsequent G-code set
–G8993, Other physical or occupational subsequent functional limitation, current status, at therapy episode outset and at
reporting intervals
–G8994, Other physical or occupational subsequent functional limitation, projected goal status, at therapy episode outset,
at reporting intervals, and at discharge or to end reporting
–G8995, Other physical or occupational subsequent functional limitation, discharge status, at discharge from therapy or to
end reporting
›.
G-code Modifier
Impairment Limitation Restriction
CH
0 percent impaired, limited or restricted
CI
At least 1 percent but less than 20 percent impaired, limited or
restricted
CJ
At least 20 percent but less than 40 percent impaired, limited
or restricted
CK
At least 40 percent but less than 60 percent impaired, limited
or restricted
CL
At least 60 percent but less than 80 percent impaired, limited
or restricted
CM
At least 80 percent but less than 100 percent impaired, limited
or restricted
CN
100 percent impaired, limited or restricted
Source: https://www.cms.gov/
.
› Reimbursement:
• In Sweden, home modifications are paid for by the government to allow individuals to live independently in their homes(8)
–Funding is provided for home modifications regardless if the home is rented or owned or if it is an apartment or house
–Healthcare professionals such as occupational therapists provide an assessment of the home and modifications are
provided by the Swedish municipality
• In the United States, Medicare B pays a percentage of cost of durable medical equipment(7)
• The Department of Veterans Affairs’ Home Improvements and Structural Alterations (HISA) program provides special
grants for eligible veterans requiring home modifications(7)
Indications for Home Modifications
› The occupational therapist performs a home evaluation and provides recommendations for those patients who continue to
want to live independently despite new injuries, illnesses, or decline in function. Occupational therapists can consult with
contractors to provide the most effective modifications for the patient
› Home modifications can provide caregivers and family members with improved tools and safety
measures.(7,13)Modifications such as grab bars, for example,can help decrease the amount of burden on a caregiver in order
to safely perform transfers
› Minimize environmental risk factors for falls, including(20)
• unsecured rugs
• rugs with curled edges
• slippery floors
• uneven surfaces (e.g., flooring, sidewalks, driveways)
• poor lighting
› Home assessments need to be client-specific, as patients will respond differently to the modifications
• An individual’s home is about personal identity and comfort; therefore, the occupational therapist must collaborate with his
or her patient and discuss what changes the patient is willing to make(4,5)
› Environmental interventions that include assistive technology and devices reduce the level of difficulty required to perform a
specific task and also allow for more independence and increased safety(3)
› Home modifications may provide a number of benefits, including:(8)
• decreasing the rate of the patient’s functional decline
• reducing overall healthcare costs
• reducing the burden of providing patient care for caregivers and family
• reducing the patient’s fear of falling
• reducing pain
• restoring dignity and relationships
Guidelines for Use of Home Modifications
› Visually impaired patients may require modifications for proper lighting at home(2)
• Automatic on/off switches including motion detection and centralized remote controls for light switches
• Properly placed lighting is important to identify hazards
• Patients may be required to modify the color of their walls and furniture to provide better contrast between objects, making
them easier to identify and avoid
› Assess the need for adaptive equipment including shower chairs, commode chairs, and grab bars
› Therapists should always collaborate with their patients to discuss what the patient is most comfortable changing(4)
Contraindications/Precautions to Home Modifications
› When providing home modifications, the occupational therapist must be mindful about other persons who may be living in
the home. Home modifications must be able to meet the needs of all other persons living in the home(5)
› The occupational therapist must assess the needs of the patient, as home modifications can be perceived negatively if the
patient’s perceived needs and values are not recognized in the assessment process(8,10)
Examination
› History
• History of present illness/injury for which the home modification is needed
–Mechanism of injury or etiology of illness: Document start of underlying condition, progression of illness/injury,
rehabilitation course, and any complications or comorbid injuries
–Course of treatment
- Medical management: Document medical interventions or surgical interventions
- Medications for current illness/injury: Determine what medications clinician has prescribed; are they being taken? Do
they impact the patient’s function?
- Diagnostic tests completed: Document diagnostic tests/lab work completed for the patient
- Home remedies/alternative therapies: Document any use of home remedies (e.g., ice or heating pack) or alternative
therapies (e.g., acupuncture) and whether they help or not. Has the patient made any changes to the home or work
environment? Are the changes safe?
- Previous therapy: Document whether patient has had occupational or physical therapy for this or other conditions and
what specific treatments were helpful or not helpful
–Aggravating/easing factors: (and length of time each item is performed before the symptoms come on or are eased)
- Could modification of the environment allow the patient to complete ADLs without aggravating symptoms (e.g., pain,
fatigue)?
–Body chart: Use body chart to document location and nature of symptoms
–Nature of symptoms: Document nature of symptoms (constant vs. intermittent, sharp, dull, aching, burning, numbness,
tingling)
–Rating of symptoms: Use a visual analog scale or 0-10 scale to assess symptoms at their best, worst, and at the moment
(specifically address if pain is present now and how much)
–Pattern of symptoms: Document changes in symptoms throughout the day and night, if any (AM, mid-day,PM, night);
also document changes in symptoms due to weather or other external variables and activities
–Sleep disturbance: Document number of wakings/night
- Is sleep disturbed by the need to urinate during the night? Is the environment safe for the patient to go to the bathroom at
night?
–Other symptoms: Document other symptoms patient may be experiencing that could exacerbate the condition and/or
symptoms that could be indicative of a need to refer to physician (e.g., dizziness, bowel/bladder/sexual dysfunction,
saddle anesthesia)
–Respiratory status: Document use of supplemental oxygen, mechanical ventilator, etc.
- Does the environment allow the patient to safely ambulate or move around with oxygen and mobility aids (as needed)?
–Barriers to learning:
- Are there any barriers to learning? Yes__ No__
- If Yes, describe__________________________
• Medical history
–Past medical history
- Previous history of same/similar diagnosis
- Comorbid diagnoses: Ask patient about other problems including diabetes, cancer, heart disease, complications of
pregnancy, psychiatric disorders, orthopedic disorders, etc.
- Medications previously prescribed: Obtain a comprehensive list of medications prescribed and/or being taken
(including over-the-counter drugs)
- Other symptoms: Ask patient about other symptoms he/she may be experiencing
• Social/occupational history:
–Patient's goals: Document what the patient hopes to accomplish with home modifications and in general. Discuss
with the patient what types of modifications may be needed and determine if patient and others living in the home are
agreeable with the potential for changes to the home. OTs need to understand the patient’s abilities, desires, and needs in
order to design the best solution possible
–Vocation/avocation and associated repetitive behaviors, if any: Is the patient employed? What type of work does the
patient do? Are any adaptations needed in the work environment similar to those needed in the home?
–Functional limitations/assistance with ADLs/adaptive equipment: Document functional limitations due to primary
diagnosis. What was the patient’s prior level of function? What adaptive equipment is in use? Does the patient use a
wheelchair?
–Living environment: Stairs, number of floors in home,number of steps to entrance, location of laundry services,location
of bedroom or sleeping area, with whom patient lives (e.g., caregiver, family members), kitchen set-up, environmental
hazards such as throw rugs or cords. Identify the barriers to independence in the home; what modifications would
improve function?
- Assess doorway width. According to the Americans with Disabilities Act (ADA), clear width of doors should be at least
32 inches(6)
- Perform an assessment of the patient’s bathroom, living room, kitchen, and bedroom and observe for items such as(7)
- Throw rugs
- Grab bars
- Are they placed in proper locations?
- Are they secured properly?
- Are there towel bars located in places where they could be used for grab bars?
- Using towel bars as grab bars is a significant safety risk. Towel bars are usually not secured into studs, nor are they
designed to withstand the forces placed on them if used to support a person’s weight
- Height of toilet seat
- Presence of non-skid mat for tub
- Bathroom chair/tub transfer bench
- Other things to consider throughout the home:(7)
- Are there railings at the front entrance?
- Is there adequate lighting throughout various parts of the home?
- Is there any loose carpeting or uneven flooring?
- Kitchen assessment (6)
- Observe height of sink and countertops; are they functional for the patient?
- For patients requiring wheelchair access, a 5’x5’ turning radius is needed
- Proper lighting throughout the kitchen
- Determine what type of lever system may be required for faucets and sinks(4)
- Organization of kitchen equipment
- Are the items used most frequently easily accessible?
- Bedroom assessment(4)
- Are there easily accessible light switches or lamps? If not, could smart home technology be implemented?
- For additional information on assistive technology, see Clinical Review…Assistive Technology for Activities of Daily
Living: Occupational Therapy CINAHL Topic ID Number: T901900 and Clinical Review…Assistive Technology for
Patients with Physical Impairments CINAHL Topic ID Number: T901901
- Remove any rugs, cords, or environmental hazards that may increase the risk for falls
- Will the patient require any bedside hand rails or trapeze to get in/out of bed safely?
› Relevant tests and measures: (While tests and measures are listed in alphabetical order, sequencing should be
appropriate to patient medical condition, functional status, and setting)
• Ergonomics/body mechanics
–Assess body mechanics with functional transfers, standing, and sitting
–Assess patient’s body mechanics and note any abnormal deviations when sitting or in upright position
• Functional mobility (including transfers, etc.)
–Assess functional mobility, including use of assistive devices; the Functional Independence Measure (FIM) can be used as
an objective measurement to assess mobility
–Note any limitations in upper-extremity range of motion, strength, or coordination negatively impacting function
• Gait/locomotion
–Screen for gait dysfunction or impaired wheelchair mobility. Refer to physical therapy as appropriate
–Does the patient use a cane or walker for mobility? Are there barriers to safe use of mobility aids?
• Motor function (motor control/tone/learning)
–Assess upper and lower extremity coordination
–Assess for abnormal tone
• Observation
–Observe the patient performing functional tasks in the home
• Perception (e.g., visual field, spatial relations)
–Assess patient’s visual acuity, eye movement, coordination, visual field, contrast sensitivity
• Posture
–Assess general posture in sitting and standing and note any abnormal postural deviations and the impact on function
• Assessment tools specific to home modification
–SAFER tool: 97-item safety-related assessment tool(1)
–Westmead Home Safety Assessment (WeHSA): home safety assessment that determines fall
risk, habits, risky situation, behaviors, and personal characteristics.(1) Can be accessed at
https://sites.google.com/site/studentcapstone122/westmead-home-safety
–Home Assessment Profile: based on client’s performance within the home. Helps to identify hazards in the home and the
frequency with which the patient will be encountering them. Can be accessed at https://instruct.uwo.ca/kinesiology/9641/
Assessments/Biological/HAP.html
–Cougar Home Safety Assessment: used to identify environmental safety hazards in homes. Cougar 4.0 addresses any fire
hazards, emergency communication and preparation, medical supplies and medication management, electrical safety,
water temperature, kitchen safety, and fall hazards in the hallways, bathrooms, and parking areas. Can be accessed at
http://www.misericordia.edu/uploaded/documents/academics/ot/ot_research/home_safety/ot_finalcougar07.pdf
–In-Home Occupational Performance Evaluation (I-HOPE) and In-Home Occupational Performance Evaluation for
Providing Assistance (I-HOPE Assist)(17)
- I-HOPE Assist may be useful for assessing impact of home modifications on the informal caregivers
–Information about additional home assessments and checklists from AOTA can be accessed at
http://www.aota.org/practice/productive-aging/home-mods/rebuilding-together/assessments.aspx
Assessment/Plan of Care
› Contraindications/precautions
• Patients with a diagnosis for which this procedure is used may be at risk for falls; follow facility protocols for fall
prevention and post fall-prevention instructions at bedside, if inpatient. Ensure that patient and family/caregivers
are aware of the potential for falls and educated about fall-preventionstrategies. Discharge criteria should include
independence with fall-prevention strategies
› Diagnosis/need for procedure
• Frail older adult patients, patients with dementia, or those with mild functional impairments may benefit from a home
assessment in order to provide recommendations for home modifications that can allow these individuals to continue to live
safely and maximally independently in their homes
• Occupational therapist may provide a pre-discharge home assessment visit to determine whether the patient is able to return
to his or her own home or require an alternative accommodation(9)
–Occupational therapist should perform a pre-discharge home visit along with the patient to assess ability to perform ADLs
and other functional tasks in his/her own environment and determine what home modifications may be required(11)
- OT can provide compensatory strategies for the patient in home as well as provide recommendations for assistive
devices and home modifications
› Prognosis
• Home modifications allow a patient to continue to “age in place” safely and independently
• A study by Stark et al. found that those patients who had their home modified reported having improvements with daily
activity functions and were able to maintain these improvements for at least 2 years(12)
› Referral to other disciplines
• Professional contractor to perform extensive modifications such as adding stair glides, ramps, hand rails, bathroom
adjustments, lowering or raising light switches, etc.
• Physical therapy for proper strengthening exercises, gait training and proper use of assistive devices, and/or balance
training activities to minimize risk for falls
• Social worker
• Nursing
› Other considerations
• Modification planning should be performed as soon as possible if a patient is being discharged to home from a hospital
• When performing home modifications, the occupational therapist as well as other professionals participating in the home
modifications should respect the final decision of the patient
• Low-income, Hispanic, and Black patients are more likely to perform their own modifications versus using outside
sources(14)
• Individuals adapt to their disabilities in unique ways. As long as the patient is safe in the adaptations, attempting to change
him or her to perform a task the “right way” may cause “challenges and discomfort” to the patient. Ask questions and
observe before making recommendations(21)
› Treatment summary
• Home safety assessments can be given to patients to allow them to evaluate the safety of their own environment and make
the necessary changes without the need of a therapist.(5) Patients are given an assessment such as the Cougar that allows
them to assess their home using a checklist
• Minor modifications to the home can include:(5)
–clearing the floor of any clutter to allow for safe mobility throughout the home
–removing any throw rugs, cords, wires
–reorganizing kitchen items that are used frequently and placing them in locations that are easily accessible to the patient
–replacing light bulbs to higher lumens to increase lighting
–rearranging furniture to allow easy access to other rooms
–For patients with arthritis, consider replacing faucets with easier to use handles or door knobs with easier to use handles
• Major home modifications require significant changes to the structure of the home and may require a professional
contractor. Changes can include:(5)
–installing new light fixtures
–installing hand rails
–widening doorways/halls
–replacing stairs with ramps or vertical lifts
–adding or renovating bathrooms
• Examples of low-cost home modifications are:
–tactile labeling systems(2)
–talking clocks and microwave ovens(2)
–audio-labeling system(2)
–lifeline medical alert service(2)
• Ramp access can benefit those patients with balance or strength deficits who require use of a wheelchair, walker, or cane
–Ramps must be built in a 1:12 ratio (12 inches of ramp for every 1 inch rise). However, some patients may have difficulty
accessing this type of ramp; thus a slope of 1:16 or 1:20 is recommended(6)
• Vertical lifts can provide access to the home when space is limited; however, they are more costly
• A swing clear hinge can be installed on doorways to provide the 32 inches of clear width space to allow the
wheelchair-bound patient plenty of room to enter the door without risk of skin tear or injuries to the hand and extremities(6)
• Valenza (2007) identifies five goals for a home modification:(4)
–Minimize tripping hazards such as wire, cords, and cables
–Maximize slip resistance (increase friction): increase traction on surfaces such as tiles and wooden surfaces by placing
adhesive strips or removing any liquids that may increase chances of a slippery surface
–Minimize overreaching: decrease the amount a patient will be required to reach by placing objects and commonly used
items in easily accessible areas
–Maximize visual support: provide proper lighting as well as easy accessible light switches. Nightlights are helpful
accessories
–Maximize physical support: items such as grab bars and specialized lift chairs can allow a patient to safely perform
transfers in a bathroom
• Both standardized assessments and informal interview should be incorporated into the home evaluation, results of which
may be used to drive subsequent treatment(19)
–For each environmental barrier identified, if possible present multiple potential solutions with varying cost and
complexity for the patient’s consideration. For example, if transporting laundry from basement is problematic, possible
solutions may include installing railings along basement stairs, relocating washer and dryer upstairs, or having caregiver
assist with transporting the laundry up and down the stairs
• Additional research is needed to support modifications for patients with Alzheimer’s disease (AD)(18)
–The authors of a review of the literature on home modifications for persons with AD recommend that any interventions
be client-centered and include the caregiver, but find that evidence is lacking as to what are appropriate evidence-based
assessments, what modifications are needed in later stages of AD, and at what stage modifications are no longer adequate
to provide a safe living environment
Desired Outcomes/Outcome Measures
› Desired Outcomes
• Functional independence
–FIM
• Minimizing risk for falls
–Berg Balance Scale
–Timed up and go (TUG)
• Continuing to live in home safely and independently(13)
• Decreasing environmental barriers to enhance overall functional outcome(13)
Patient Education
› Patients looking to find more information on home modifications can visit http://www.eldercare.gov/Eldercare.NET/Public/
Resources/Factsheets/Home_Modifications.aspx
› AARP provides information on home modifications at
http://www.aarp.org/home-family/caregiving/info-2014/caregiving-home-safety-modifications-ginzler.html
› AOTA home modifications information can be found at http://www.aota.org/Practice/Productive-Aging/Home-Mods.aspx
Coding Matrix
References are rated using the following codes, listed in order of strength:
M Published meta-analysis
SR Published systematic or integrative literature review
RCT Published research (randomized controlled trial)
R Published research (not randomized controlled trial)
RV Published review of the literature
RU Published research utilization report
QI Published quality improvement report
L Legislation
C Case histories, case studies
PGR Published government report
G Published guidelines
PFR Published funded report
PP Policies, procedures, protocols
X Practice exemplars, stories, opinions
GI General or background information/texts/reports
U Unpublished research, reviews, poster presentations or
other such materials
CP Conference proceedings, abstracts, presentation
References
1. Fisher GS, Baker A, Koval D, Lishok C, Maisto E. A field test of the Cougar Home Safety Assessment (version 2.0) in the homes of older persons living alone. Aust Occup Ther
J. 2007;54(2):124-130. (R)
2. Gentry T, Copolillo AI, Ivanoff SD. Assistive technology and home modification for people with neurovisual deficits. Neurorehabilitation. 2011;28(3):211-220.
doi:doi:10.3233/NRE-2011-0650. (RV)
3. Petersson I, Lilja M, Hammel J, Kottorp A. Impact of home modification services on ability in everyday life for people ageing with disabilities. J Rehabil Med.
2008;40(4):253-260. doi:10.2340/16501977-0160. (R)
4. Valenza T. Home sweet home modification. Rehab Manag. 2007;20(5):12-19. (X)
5. Weeks AL, Lamlb BA, Pickens ND. Home modification assessments: Clinical utility and treatment context. Phys Occup Ther Geriatr. 2010;8(4):396-409.
doi:10.3109/02703180903528405. (X)
6. Petitio C. Beyond the wheelchair: Home modification unites function and form by exploring household’s big picture. Rehab Mag. 2011;24(6):10-13. (X)
7. Horowitz BP, Nochajski SM, Schweitzer JA. Occupational therapy community practice and home assessments: Use of the home safety self-assessment tool (HSSAT) to
support aging in place. Occup Ther Health Care. 2013;27(3):216-227. doi:10.3109/07380577.2013.807450. (R)
8. Johansson K, Lilja M, Petersson I, Borell L. Performance of activities of daily living in a sample of applicants for home modification services. Scand J Occup Ther.
2007;14(1):44-53. (R)
9. Harris S, James E, Snow P. Predischarge occupational therapy home assessment visits: Towards an evidence base. Aust Occup Ther J. 2008;55(2):85-95.
doi:10.1111/j.1440-1630.2007.00684. (R)
10. Tanner B, Tilse C, de Jonge D. Restoring and sustaining home: The impact of home modifications on the meaning of home for older people. J Housing Elderly. 2008;22(3). (R)
11. Wilson L, Atwal A, Richards C, McIntyre A, Johnston K, Lilja M. Do occupational therapy pre-discharge home visits affect the longer term outcomes of the discharge process?
Int J Ther Rehabil. 2012;19(6):335-342. doi:10.12968/ijtr.2012.19.6.335. (R)
12. Stark S, Landsbaum A, Palmer JL, Somerville EK, Morris JC. Client-centred home modifications improve daily activity performance of older adults. Can J Occup Ther.
2009;76:235-245. (R)
13. Ahn M, Hegde AL. Perceived aspects of home environment and home modifications by older people living in rural areas. J Housing Elderly. 2011;25(1):18-30.
doi:10.1080/02763893.2011.545735. (R)
14. Etman A, Wijlhuizen GJ, van Heuvelen MJ, Chorus A, Hopman-Rock M. Falls incidence underestimates the risk of fall-related injuries in older age groups: A comparison with
the FARE (Falls Risk by Exposure). Age Ageing. 2014;41(2):190-195. doi:10.1093/ageing/afr178. (RV)
15. Renda M, Shamberg S, Young D. Complex environmental modifications. Am J Occup Ther. 2015;69(3):1-7. doi:10.5014/ajot.2015.696S01. (GI)
16. Backner S. Easy come, easy go! easy everything in-between! part II. Am J Occup Ther. 2015;28(6):26-29. (C)
17. Keglovitis M, Somerville E, Stark S. In-home occupational performance evaluation for providing assistance (I-HOPE Assist): an assessment for informal caregivers. Am J
Occup Ther. 2015;69(5):1. doi:10.5014/aot.2015.015288. (R)
18. Struckmeyer LR, Pickens ND. Home modifications for people with Alzheimer’s disease: a scoping review. Am J Occup Ther. 2016;70(1):1-9. doi:10.5014/ajot.2015.016089.
(SR)
19. Sommerville E, Smallfield S, et al. Occupational therapy home modification assessment and intervention. Am J Occup Ther. 2016;70(5):1-3. doi:10.5014/ajot.2016.705002. (X)
20. Saadat S, Hafezi-Nejad N, Ekhtiari YS, et al. Incidence of fall-related injuries in Iran: a population-based nationwide study. Injury. 2016;1304-1409. doi:10.1016/
j.injury.2016.05.001. (R)
21. Staver C. Finding the “right” way to do home modifications. OT Practice. 2015;20(16):15-16. (X)